500 N. Western Avenue • Suite 100 • Sioux Falls, SD • 57104 • Telephone 605.367.5353 • Fax 605.367.5394
E-Mail: [email protected] OR [email protected]
SECTION 1: APPLICATION CHECKLIST
Dakota BUSINESS Finance staff is available to assist the borrower in completing the application materials required by the
SBA 504 program. All forms are also available online at www.dakotaBUSINESSfinance.com.
General Application
X N/A Description
Completed and Signed Dakota Business Finance Loan Pre-Application (Section 2, 7)
Bank Information Release Form (Section 4)
SBA Release Form (Section 5)
Business Information
X N/A Description
Franchise Agreement (includes any dealer agreements, jobber agreements, license agreements, etc.)
Year-end business financial statements (balance sheet and income statement) for the last 3 years for
the Operating Company
Year-end business financial statements (balance sheet and income statement) for the last 3 years for
the Eligible Passive Company (real estate holding company)
Federal tax returns for the last 3 years for the Operating Company
Federal tax returns for the last 3 years for the Eligible Passive Company (real estate holding company)
Business Debt Schedule (Section 6)
Interim financial statement dated within the last 60 days for the Operating Company as well as an aging
of Accounts Receivable and Accounts Payable
Interim financial statement dated within the last 60 days for the Eligible Passive Company (real estate
holding company) as well as an aging of Accounts Receivable and Accounts Payable
Projected annualized income statement for the Operating Company for the first two years after the loan;
Must include a description of assumptions made in developing the projections. (May contact Small
Business Development Center for assistance 605-367-5757)
For a new business (less than 2 years in existence) a monthly cash flow analysis for the first 12 months
of operation or for 3 months beyond the break-even point (whichever is longer) together with a
description of assumptions (May contact Small Business Development Center for assistance 605-3675757)
For a new business (less than 2 years in existence) projected balance sheet with a description of the
assumptions attached (May contact Small Business Development Center for assistance 605-367-5757)
Organizational documents including Certificate of Incorporation, Articles of Incorporation and By-Laws
(if Corporation); or Articles of Organization and Operating Agreement (if LLC); or Partnership
Agreement (if Partnership); Business License and Fictitious Business Name Statement (if
proprietorship).
The names of any affiliated (through ownership or management control) business as well as tax returns
for the last two years and interim financial statements dated within the last 60 days
(Continued on Next Page)
Personal Information for each owner of 20%+or guarantor
X N/A Description
Personal tax returns for the last 2 years
Personal Resume / History Form (Section 3)
Personal financial statement (form included or use any template; Must be dated within 90 days of
application to SBA)
Photocopy of driver’s license/ I.D. card
Real Estate Information
X N/A Description
Real Estate Purchase Agreement or settlement sheet
Construction cost estimates or bids (must be on contractor letterhead); blueprints, plans/specifications
Equipment invoices or quotes
Copies of proposed/existing lease agreements
Existing / new environmental studies (needed prior to closing)
Real estate appraisal, if already completed (needed prior to closing)
Provided by Bank
X N/A Description
Copies of personal credit reports for each owner of 20%+ and each guarantor
Copies of business credit reports for the business and any affiliate
Commitment letter from the participating lender stating the terms and conditions of its participation and
reason why it will not finance the entire project
Commitment letter from all other sources of financing involved in the project
SECTION 2: LOAN PRE-APPLICATION
Eligible Passive Company (Owner of Real Estate), if applicable
(How the real estate will be owned (i.e. individually, husband and wife,
partnership, LLC, corporation, trust, etc.)
Eligible Passive Company Name______________________________________________________________________________________________
Address________________________________________________
City___________________________
State____________
Zip__________
Principal in charge_______________________________________
Business Phone (_____)_____________
E-mail Address___________________________________________
Type of business__________________________________________________
Cell (____)___________________
Company Website _________________________________________________________________________________________________________
Type of Entity (check one)
Proprietorship
Partnership
Corporation
Federal Employer Identification Number (EIN) _______________________________
LLC
Other ________________________________
Date established_____________________________________
Eligible Passive Company Ownership
Name___________________________________________________
Title________________________________
% of Ownership_____________
Name___________________________________________________
Title________________________________
% of Ownership_____________
Name___________________________________________________
Title________________________________
% of Ownership_____________
Operating Company
Operating Company Name______________________________________________________________________________________________
Address________________________________________________
City___________________________
Principal in charge_______________________________________
Business Phone (_____)_____________
E-mail Address___________________________________________
Type of business__________________________________________________
Type of Entity (check one)
Proprietorship
Partnership
Corporation
Federal Employer Identification Number (EIN) _______________________________
LLC
State____________
Zip__________
Cell (____)___________________
Other ________________________________
Date established_____________________________________
Operating Company Ownership
Name___________________________________________________
Title________________________________
% of Ownership_____________
Name___________________________________________________
Title________________________________
% of Ownership_____________
Name___________________________________________________
Title________________________________
% of Ownership_____________
Name___________________________________________________
Title________________________________
% of Ownership_____________
Name___________________________________________________
Title________________________________
% of Ownership_____________
Affiliate Business (If Applicable)
Name___________________________________________________
Owner______________________________
% of Ownership_____________
(Applicant Company or Individuals)
Name___________________________________________________
Owner______________________________
% of Ownership_____________
(Applicant Company or Individuals)
Name___________________________________________________
Owner______________________________
% of Ownership_____________
(Applicant Company or Individuals)
Existing Business Locations
Address_________________________________________________ Square Feet______ Lease payment_________
Replaced by new facility? _________
Address_________________________________________________ Square Feet______ Lease payment_________
Replaced by new facility? _________
Lease Expiration__________
Lease Expiration__________
References
Bank name____________________________
Acct. no.________________
Acct. officer__________________________
Phone______________
Accountant____________________________
Firm name_____________________________________________________
Attorney______________________________
Firm name_____________________________________________________ Phone_____________
Phone_____________
Nature of Your Business
When and by whom was your company established?______________________________________________________________________________
When did you gain control of the business?______________________________________________________________________________________
Type of products or services (include any catalogs or brochures)_____________________________________________________________________
________________________________________________________________________________________________________________________
Geographic market area_____________________________________________________________________________________________________
________________________________________________________________________________________________________________________
List key customers__________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
List major competitors_______________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Project Information
Project Property Address_____________________________________________________________________________________________________
City ___________________________________________________ State________________ Zip______________ County_____________________
What is the square footage of the new building? ___________________ What is the square footage your company will occupy?*_________________
*Please note – SBA requires the Operating Company to occupy 51% of an existing building and 60% of a new building immediately.
Purchase Agreement Expiration Date ______________________________ Realtor’s name ____________________________________________
Total Project Costs
Purchase existing building
Construction Project
Purchase price
$___________________
Land acquisition
$___________________
Improvement
$___________________
Construction bid
$___________________
Equipment*
$___________________
Architects, permits, other soft costs
$___________________
Other
$___________________
Equipment*
$___________________
$___________________
Other
$___________________
Total
Total
$___________________
* Please note – equipment to be financed must have a useful life of 10 years or greater.
If there are any tenants that will remain in the building, please provide the following Information: Also, please have your realtor provide copies of all existing leases.
Tenant name
Square footage occupied
Lease expiration
Rent amount
Employee Questionnaire
Current:
Number of current full-time (FT) employees
_________
Number of current part-time (PT) employees
_________
Average # of hours per week part-time (PT) employees work _________
Job Creation:
Estimated number of new full-time (FT) employees within the next two years as a result of this project
Estimated number of new part-time employees within the next two years as a result of this project
Estimated average # of hours per week new part-time employees (as a result of this project) will work
_________
_________
_________
Key employees:
Name
Title
Responsibilities
Years with
company
Years in the
industry
Miscellaneous Questions
Have you or any officer of your company ever been involved in bankruptcy or insolvency proceedings? ____________
Are you or your business involved in any pending or prior lawsuits? _______________
Have you ever received an SBA loan? ____________
If yes, please provide details on a separate sheet.
If yes, please sign the SBA Release Form (Section 5) to allow Dakota Business Finance to
contact SBA for additional information.
Where will your equity injection for this project be provided from? _____________________________________________________________________
Previous Government Financing
List all previous debts sponsored by the Federal Government, which may include student loans, home loans, farm loans,
SBA loans, etc. for: 1) Operating Company, 2) Eligible Passive Company, and 3) each owner of 20% or greater.
Federal Agency & Loan Number (if known)
Agency:
Loan Number:
Borrower:
Agency:
Loan Number:
Borrower:
Agency:
Loan Number:
Borrower:
Agency:
Loan Number:
Borrower:
Agency:
Loan Number:
Borrower:
Agency:
Loan Number:
Borrower:
Agency:
Loan Number:
Borrower:
Original Date
Original Amount
Current Balance
Status
SECTION 3: PERSONAL RESUME / PERSONAL HISTORY FORM
Personal Resume / Personal History Form
To Be Completed by Each Principal / Personal Guarantor
Name ____________________________________________________________________________________________________________________
First
Middle
Maiden
Dates Maiden Name Used
Last
Date of birth ________________ Place of birth_____________________ Race___________________ Social Security No. _____________________
U.S. Citizen – if not, please provide alien registration number _______________________________________
Home address_______________________________________________ City_____________________ State______________ Zip______________
From (mo./yr.)______________ To (mo./yr.)_______________ Home phone _______________________ Business phone______________________
Are you employed by the U.S. Government?_____________________ If so, give the name of the agency and position__________________________
Most Recent Prior Address (omit if over 10 years)_________________________________________________________________________________
From (mo./yr.)______________ To (mo./yr.)_______________
Spouse’s name ____________________________________________________________________________________________________________
First
Middle
Maiden
Dates Maiden Name Used
Last
Date of birth ________________ Place of birth_____________________ Race___________________ Social Security No. _____________________
Personal information
Be sure to answer the next three questions correctly because they are important. The fact that you have an arrest or
conviction record will not necessarily disqualify you; an incorrect answer will probably cause your application to be turned
down.
Are you presently subject to an indictment, criminal information, arraignment, or other
means by which formal criminal charges are brought in any jurisdiction? --------------------------------
Yes
No
Have you been arrested in the past six months for any criminal offense? -------------------------------
Yes
No
For any criminal offense – other than a minor vehicle violation – have you ever: 1) been
convicted; 2) plead guilty; 3) plead nolo contendere; 4) been placed on pretrial diversion;
or 5) been placed on any form of parole or probation (including probation before judgment).-------
Yes
No
If yes to any of the above, additional details will be required. Dakota Business Finance will contact you for additional
information.
Military service background
Branch ______________________________________________________________________ From__________________ To__________________
Rank at discharge________________________ Honorable?______________________
Job description ____________________________________________________________________________________________________________
(Continued on Next Page)
Personal Resume / Personal History Form
Continued
A formal resume may be submitted in place of this page of the Personal Resume / Personal History Form.
Work experience
Name of company_____________________________________________________________________
% of business owned__________________
Full address_________________________________________________ City_____________________ State______________ Zip______________
From ________________________ To__________________________ Title ___________________________ Duties_________________________
_________________________________________________________________________________________________________________________
Name of company_____________________________________________________________________
% of business owned__________________
Full address_________________________________________________ City_____________________ State______________ Zip______________
From ________________________ To__________________________ Title ___________________________ Duties_________________________
_________________________________________________________________________________________________________________________
Name of company_____________________________________________________________________
% of business owned__________________
Full address_________________________________________________ City_____________________ State______________ Zip______________
From ________________________ To__________________________ Title ___________________________ Duties_________________________
_________________________________________________________________________________________________________________________
Education (College or Technical Training)
Name and Location
Dates Attended
Major
Degree or Certificate
1. _____________________________________________________ _______________________ ____________________ ____________________
Comments________________________________________________________________________________________________________________
2. _____________________________________________________ _______________________ ____________________ ____________________
Comments________________________________________________________________________________________________________________
3. _____________________________________________________ _______________________ ____________________ ____________________
Comments________________________________________________________________________________________________________________
4. _____________________________________________________ _______________________ ____________________ ____________________
Comments________________________________________________________________________________________________________________
SECTION 4: BANK RELEASE FORM
DATE:
Bank Contact:
Bank Name:
Bank Address:
City/State/ZIP:
I (We), _________________________, hereby authorize the release of all loan information for
the ___________________________ project located in ___________________, SD and all
corresponding information (i.e. financial information, schedules, tax returns, application, credit
reports, etc.) I (we) have provided to ____________________ (bank).
Please release all information to:
South Eastern Development Foundation and/or Dakota BUSINESS Finance
500 N. Western Avenue, Suite 100
Sioux Falls, SD 57104
Thank you for your assistance. Please feel free to contact me with any questions.
Sincerely,
_______________________________
(Name) - Signature
SECTION 5: SBA RELEASE FORM
DATE: _______________________
Small Business Administration
2329 North Career Avenue, Ste. 105
Sioux Falls, SD 57107
I (We), ________________________________, hereby authorize the release of loan
information related to all previous SBA loans that I (we) have had personally or in the name of
any business in which we had an ownership interest at the time that the SBA loan was secured.
I (We) authorize the release of the following information:
1.
Loan Date
2.
Borrower Name
3.
Loan Number
4.
Original Amount
5.
Current Balance
6.
Monthly Payment Amount
7.
Status (current, delinquent, previously delinquent, in liquidation, etc).
Please release all information to:
Dakota BUSINESS Finance
500 N. Western Ave., Suite 100
Sioux Falls, SD 57104
Thank you for your assistance. Please feel free to contact me with any questions.
Sincerely,
_______________________________
(Name) - Signature
SECTION 6: BUSINESS DEBT SCHEDULE
Furnish the following information on all installment debts, contracts, notes, and mortgages payable.
Company Name _______________________________________ Date:______________________*
Creditor
Name/address
Original
Amount
Original
Date
Total present balance**
* Should be the same date as current financial statement
Present
Balance
Interest
Rate
Maturity
Date
Total monthly payment
** Total must agree with balance shown on current financial statement.
Monthly
Payment
Security
Current or
delinquent
SECTION 7: CERTIFICATIONS
I/We hereby authorize the release to Dakota BUSINESS Finance of any information they may require at any time for any
purpose related to my/our credit transaction with them, including but not limited to credit checks or inquiries concerning
my/our creditworthiness, credit standing, credit capacity, character, or general reputation. I/We further authorize Dakota
BUSINESS Finance to release such information to any entity they deem necessary for any purpose related to my/our
credit transaction with them.
I/We hereby certify that the enclosed information, including any attachments or exhibits provided here within or at a later
date, is valid and correct to the best of my/our knowledge.
IMPORTANT INFORMATION ABOUT IDENTIFICATION
PROCEDURES WHEN OBTAINING A 504 LOAN
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all Certified
Development Companies to obtain, verify, and record information that identifies each person who applies for a 504 Loan.
When you apply for a 504 Loan, we will ask for your name, address, date of birth, and other information that will allow us
to identify you. We may also ask to see your driver’s license or other identifying documents.
CERTIFICATION
All information contained in the Dakota BUSINES Finance loan application, dated ______________, and in schedules or
other documentation attached hereto are true and complete to the best knowledge and belief of the applicant. There is no
intent to deceive or defraud Dakota BUSINESS Finance or any potential participant in any loans to finance this project.
Applicant recognizes that this is an ongoing certification that the information contained herein is accurate and pledges to
supplement this application at any time necessary to add, update, or correct information previously supplied.
The Applicant recognizes that DBF may not process any application that is not complete. Incomplete applications will be
returned to the applicant for completion.
The Applicant also recognizes that, not withstanding any assurance, guarantee, communication, or representation made
to the contrary, there shall be no commitment of any loan program without specific authorization of the Board of Dakota
BUSINESS Finance. Only the DBF Board is authorized to make a commitment to loan funds from or through DBF to an
applicant.
DBF does not discriminate on the basis of race, color, religion, national origin, sex, marital status, or age.
Applicant and any signatory below hereby certify that the forgoing and any supplemental information provided is true and
complete to the best of Applicant’s/signatory’s knowledge and belief and signs this document under penalty of perjury.
Applicant also authorizes that, upon Dakota BUSINESS Finance receiving an official authorization from the Small
Business Administration approving the loan, Dakota BUSINESS Finance has the authority to release and disclose to the
general public information regarding the applicant’s identity and relationship with the Dakota BUSINESS Finance, such
as: the name of the applicant business(es), address, number of jobs created/retained, location, and photos of the
business(es). Applicant agrees and understands that the above information is being provided for publicity and/or program
funding reasons only.
Name/Title of Applicant ____________________________________________________
Signature of Applicant _____________________________________________________
Date _______________
Name/Title of Applicant ____________________________________________________
Signature of Applicant _____________________________________________________
Date _______________